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Foreword To review influenza pandemic of 1918-1919 is an enormous undertaking. J.M. Barry’s excellent study is over 700 pages long and it mainly deals with events in The United States. How, then, does one attempt to convey the gravity of a pandemic in a manner that can be assimilated more easily? The way I have chosen is to present the effects of the Flu on simply one city during its most grueling month. Philadelphia, in a sense, will serve as a microcosm of the events surrounding the Great Influenza Pandemic of 1917-1919 across the globe.  Paul Rega, M.D.

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Philadelphia in 1917 1.75 million Slums worse than in NYC Housing scarce 4 families per apartment sleeping in shifts “…the worst-governed city in America.” L Steffens Victim of a strong political machinery. Graft, corruption Social services suffered as a result City government power split among political boss, precinct captains, and mayor.

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Autopsy Reports No organ untouched. Kidneys, liver, adrenals, testes Marked hyperemia of the brain. Pericarditis, myocarditis. Lungs: Findings similar to that found in plague lungs or lungs exposed to toxic gas.

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US Flu Stats 47% of all US deaths were from flu at that time. 1918-1919: 675,000 died. Equivalent to 1,750,000 now. 15 times as many civilians died as military. Most vulnerable: Pregnant females. Anywhere from 23-71% depending on area

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September 15 600 sailors are hospitalized at Navy Hospital. More are sent to the civilian Pennsylvania Hospital in the city. 5 doctors and 14 nurses collapse 2 days later. Krusen denies threat to the city. Meanwhile, 1000 die in Boston from flu. He has meeting with local medical experts and agrees to monitor events.

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Between September 15 and 20 Plummer and Krusen They believe they have a handle on the situation. Municipal Hospital for Contagious Diseases opens its doors to increasing numbers of ill sailors. Civilians in the city begin dying with growing regularity.

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September 21 Board of Health announces “flu” to be a reportable disease It announces to the public: Stay warm Keep feet dry Keep the bowels open Avoid crowds

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Avoid Crowds?? Could be a problem: On September 28, the Great Liberty Loan Parade has been scheduled to run. Hundreds of thousands are expected to attend.

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Great Liberty Loan Parade and Local Medical Experts Local infectious disease experts and general physicians want the Parade cancelled in order to limit disease transmission.

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Request Denied The United States posture was focused totally on the war. It was crucial to keep morale high. The Parade was important for morale. Meanwhile any controversy or discontent was discouraged across the country. Free speech discouraged. Union halls raided. 1200 union workers locked in boxcars. Eugene V. Debs jailed 10 yrs for opposing war. So, it is not surprising that the concerns of the medical community in Philadelphia were not published in the Press.

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September 26 1400 sailors hospitalized so far. Local Red Cross opens the first alternative care site in the city. 500 bed United Service Center

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October 1 All beds in all 31 hospitals are filled. Hospitals refuse admission unless patient has a doctor or police order. Nurses refuse $100 bribes. Lines of people are waiting to get into Pennsylvania Hospital. Doctors and medicines are at a premium. 117 die that day.

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October 3: Krusen Acts All public meetings are banned. All churches, schools, theaters, courts are closed. No public funerals Amazingly, saloons stay open! Why? They are a key voting bloc for the political machine. Nevertheless, they are closed the next day by the State Health Commissioner.

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Emergency Hospital #1 Another alternative care site opens at the City Poorhouse. 500 beds are filled in a single day. Eventually 12 similar sites open across the city.

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In 10 Days The Flu takes a stranglehold on the community. Escalation of cases: From a few hundred sick civilians to hundreds of thousands ill. From 1-2 deaths per day to hundreds of dead in a single day. Still, the newspapers stay mute!

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Placards Disseminated Across the City “Avoid Crowds” “Use Handkerchiefs” “Spitting Equals Death” Arrested if caught spitting. 60 arrested in 1 day for spitting in public.

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October 5 254 deaths on this day. Public health authorities announce: The peak of the disease has been reached!

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October 9 428 deaths today. That toll will double in the next few weeks. 2/3 of the dead are under 40 years of age.

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The Dead Gravediggers refuse to bury them. Bodies begin to pile up. Coffins accumulate in funeral homes. A casket shortage develops. Armed guards are posted by unused caskets. Dead family members lie next to their ill relatives for days because everyone is too weak to move them. In some homes, families pack their dead in ice while waiting for removal. Stench is unimaginable. Bodies are placed on porches to be picked up by “dead wagons”.

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Mental Stress People increasingly isolated. They avoid each other for fear of contracting disease. There are no social activities. Public gatherings were banned. Phone company allows only emergency calls. No social interaction even from a distance.

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Medical/Pharmaceutical Students 5 medical schools and 1 pharmaceutical school are located in Philadelphia. They dispatch their students to assist. 1 medical student is placed in charge of an entire floor at one of the Emergency Hospitals. ¼ of his patients die each day.

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More Help? From National Red Cross: Nothing From PHS: Nothing From the City: Nothing “..death toll for 1 day in Philadelphia alone was more than the death toll from France for the whole American army for one day.”

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The Women Take Charge From the oldest and wealthiest families. They created Council of National Defense Emergency Aid Society They provided Organization and leadership Money They acted independently of Public Health.

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Emergency Aid Society Uses existing system to distribute everything from medical care to food. Divides city into 7 districts. Dispatches doctors according to geography. Develops “databank” of physicians. 24 hour phone bank for information and referrals. Soup kitchens in public schools for the ill. Recruits volunteers by the thousands. They use their private cars as ambulances. They drive physicians on rounds.

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Krusen Wakes Up Gives the rich women control of nurses. Seizes $100,000 in the emergency fund and $25,000 in the war emergency fund Supplies hospitals. Hires doctors (twice what PHS paid). Sends doctors to police stations to provide care. Cleans streets. Requests Feds not to draft Philadelphia doctors. Approved

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October 10 759 die. Before the flu, death from all causes averaged 485 per week in Philadelphia. Orphans abound.

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The Unsung Heroes Attrition rate for volunteers is high. Medical profession continues its efforts. Few flee. Police continues its heroic activities. A request went out to them for 4 volunteers to remove decomposed bodies. 118 responded!